| NPI | 1225667454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0073640) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.148537) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2026-04-07 |